Legislature(2015 - 2016)CAPITOL 106
03/17/2016 03:00 PM HEALTH & SOCIAL SERVICES
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HB 237-INTERSTATE MEDICAL LICENSURE COMPACT 4:35:48 PM CHAIR SEATON announced that the final order of business would be HOUSE BILL NO. 237, "An Act relating to an interstate compact on medical licensure; amending the duties of the State Medical Board; and relating to the Department of Public Safety's authority to conduct national criminal history record checks of physicians." 4:36:19 PM TANEEKA HANSEN, Staff, Representative Paul Seaton, Alaska State Legislature, stated that this was model legislation, and that there were currently 12 states in the Compact, with 14 other states, including Alaska, considering this legislation. She paraphrased from the FAQ [included in members' packets], which read: The Interstate Medical Licensure Compact would create a new pathway to expedite the licensing of physicians seeking to practice medicine in multiple states. The proposal could increase access to health care for individuals in underserved or rural areas and allow patients to more easily consult medical experts through the use of telemedicine technologies. The Compact would make it easier for physicians to obtain licenses to practice in multiple states and would strengthen public protection because it would help states share investigative and disciplinary information that they cannot share now. MS. HANSEN reviewed the proposed bill, and stated that the first six Sections were conforming language and applied to existing state statute of the medical board. These sections directed the board to implement the Compact. She directed attention to Section 2, which added to the board requirement that a physician shall submit their fingerprints along with their application and fees for an expedited license and a national criminal history record check. She noted that the medical board did not currently do background checks for applicants, and were not currently authorized to do so. She pointed out that a background check was required for this expedited license. CHAIR SEATON clarified that an expedited license through the Compact would have a more thorough background check than someone solely applying for a license in Alaska. MS. HANSEN expressed agreement, specifically for the criminal background check connected with fingerprints. She surmised that unless a background check was specifically noticed in statute, it was not allowed. 4:39:49 PM MS. HANSEN moved on to page 5 of the proposed bill, and addressed the definition for an eligible physician to this expedited license, which included graduation from an accredited medical school, passing each component of a licensing examination, successfully completing graduate medical education, a specialty certification from the American Board of Medical Specialists, and a full and unrestricted license to engage in the practice of medicine. They would also never have been convicted of an offense by a court of appropriate jurisdiction, never held a license subject to discipline, and were not under active investigation. MS. HANSEN stated that there were similar licensing requirements by the State of Alaska, which included graduation from a medical school and no encumbrance on your license. She relayed that the requirements under the Compact were more specific, noting that Alaska did not require the specialty certification. She reported that the idea behind the Compact was to allow any physician who qualified to pay the necessary fees and have license in another Compact state. They would be responsible for all medical and malpractice laws in each state they were licensed. She shared that there were concerns for the relinquishing of state authority to the federation of state medical boards; however, she pointed out that each of the voting members of the Commission were members of the state medical board from the member states. 4:44:19 PM REPRESENTATIVE TARR referenced the aforementioned letter from Ms. Maureen Powers, dated February 11, 2016, [included in members' packets], which read: "There is no discretion to look at moral character, malpractice history, training irregularities, or other requirements." She asked what would happen in a circumstance related to any of those issues if one of the Compact states had a more restrictive statute than another; which would take precedence, the more restrictive or the least restrictive. MS. HANSEN explained that the qualifications for the expedited licenses were presented in the Compact. She stated that these were stricter than the Alaska statutes, as the Compact was drafted to be the strictest version of the licensure requirements; hence the reason for inclusion of the specialty certification. She relayed that an intention of the Compact was to hold those physicians applying for the expedited licensure to the highest level of requirements. She noted that a physician could apply using a normal procedure through the individual state medical boards if they did not qualify for the expedited license. REPRESENTATIVE TARR asked about the cost of the recertification process mentioned in the aforementioned letter, and whether it was possible to "sync up" during the next natural recertification. MS. HANSEN replied that the Compact had no effect on current licensees unless they desired to get an expedited license for automatic licensing in other Compact states. REPRESENTATIVE TARR mused that the physician could then continue their scope of practice and not engage in activities outside the state. 4:47:40 PM CHAIR SEATON reminded the committee that the proposed bill was being considered because it took so long for many doctors to get licensed in Alaska, and that this was an attempt to make the system work better to more easily get physicians into the state. He stated that, as the state did not want to lose doctors because of delays in the state's system, a doctor already having a license in a Compact state could more easily get the expedited license. He emphasized that all the fees still had to be paid. REPRESENTATIVE WOOL asked if this would affect a newly licensed medical professional coming to Alaska to practice for the first time. MS. HANSEN replied that, as a requirement to receive the expedited license was to already possess a license, they would have to go through the examination process. CHAIR SEATON pointed out that someone with a specialty license, as well as licenses in other states, who was still waiting for an Alaska license under the current system, could apply through the Compact if they met all the other criteria. He clarified that a specialty license included family practice and preventative medicine, and was not limited to brain surgery. MS. HANSEN explained that any disciplinary action or suspension in one state would result in notification to the other Compact states, each of which would then decide whether to maintain the action or reinstate the license. REPRESENTATIVE WOOL asked if a practitioner in another state could come to Alaska and apply for a license through the current system, opting to not apply through the Compact because of a prior disciplinary action in a Compact state. MS. HANSEN replied that the Alaska State Medical Board would also review disciplinary actions, but allowed for the possibility of more leniency should the board decide that action was not a concern. She opined that for a physician applying under the language of the Compact, the Alaska State Medical Board would not have this discretion. 4:52:54 PM CHAIR SEATON opened public testimony. 4:54:03 PM JAY BUTLER, MD, Chief Medical Officer/ DPH Director, Central Office, Division of Public Health, Department of Health and Social Services, listed some of the advantages for participation in the Compact which included increased ease in recruiting and faster "on-boarding" of providers when they arrived in Alaska. This allowed for providers and sub-specialty providers to begin service more quickly in underserved areas and facilities. He reported that this also streamlined the participation and availability by out of state providers in limited emergency and disaster responses, those events that were not big enough to lead to a state disaster declaration and the use of federal assets, such as a localized infectious disease outbreak. REPRESENTATIVE WOOL asked if this would allow the inclusion of providers from another Compact state through telemedicine. This would allow medical personnel to have multiple licenses while residing in only one state. DR. BUTLER replied that it would be included if the requirement for provision of telemedicine services included medical licensing in Alaska. CHAIR SEATON shared that these requirements included those in the upper levels of the profession to receive the expedited license. 4:57:33 PM KEVIN LUPPEN, Alaska State Medical Board, stated the support of the Alaska State Medical Board for the proposed bill, HB 237. He offered a personal anecdote for the loss of practitioners because of the current delays in licensing. REPRESENTATIVE TARR asked if the Alaska State Medical Board were related to the Federation of State Medical Boards. MR. LUPPEN replied no. REPRESENTATIVE TARR asked if there was any mistrust with this national organization. MR. LUPPEN replied that there had not been any concern from the state board with the national organization, and that some trends and expertise had been provided to the state board. He stated that he had not seen any potential threats from the national organization. 5:00:11 PM CHAIR SEATON directed attention to page 7, line 8, of the proposed bill which stated the requirement that a formal license application had to be submitted, contrary to the claims of the aforementioned letter to the committee. 5:01:32 PM CHAIR SEATON closed public testimony after ascertaining no one further wished to testify. 5:01:43 PM REPRESENTATIVE VAZQUEZ directed attention to page 4, line 2, of the proposed bill, and she highlighted that the Compact did not change the existing medical practice act of the state. She read from page 4, line 7, of the proposed bill: State medical boards that participate in the Compact retain the jurisdiction to impose an adverse action against a license to practice medicine in that state issued to a physician through the procedures in the Compact. REPRESENTATIVE VAZQUEZ pointed to page 6, lines 22-25, of the proposed bill, which clarified that the proposed bill did not usurp the current Alaska law. 5:03:31 PM REPRESENTATIVE VAZQUEZ moved to report HB 237, labeled 29- LS1100\A, out of committee with individual recommendations and the accompanying indeterminate fiscal notes. There being no objection, HB 237 was moved from the House Health and Social Services Standing Committee.